Provider Demographics
NPI:1093443335
Name:SP MEDICAL SERVICES PA
Entity Type:Organization
Organization Name:SP MEDICAL SERVICES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:W
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH, CPE, FAPA
Authorized Official - Phone:603-828-3759
Mailing Address - Street 1:481 WYTHE AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11249-6183
Mailing Address - Country:US
Mailing Address - Phone:866-702-1494
Mailing Address - Fax:
Practice Address - Street 1:481 WYTHE AVE STE 102
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11249-6184
Practice Address - Country:US
Practice Address - Phone:866-702-1494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-14
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty